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1.
Indian J Public Health ; 65(4): 332-339, 2021.
Article in English | MEDLINE | ID: covidwho-1608240

ABSTRACT

The debate around approaches to health sector reform is one of the foundational questions around which the discipline of health policy and systems research has grown. In the immediate postwar period, health and health care were recognized as areas of market failure, requiring state action in the provision of free or subsidized services. In the eighties and nineties, due to both geopolitical and ideological reasons, this understanding changed, leading to a wave of market-based health sector reforms. An academic discourse built around neoliberal economics initiated, shaped, and legitimized these reforms. Faced with worsening health outcomes and costs of care after a decade of such reforms, there was a partial reversal of policy toward improving health sector performance that relied on nonmarket solutions built around notions of solidarity, trust, and rights. In India, this took the form of the National Rural Health Mission. Examples of health systems research that supported this direction of change are discussed. In the last decade, a second wave of health sector reforms sought to make markets work by repositioning government as purchaser of health care from private providers through insurance and contracts. There is little evidence that this worked. The need to rely on public services to cope with the COVID-19 pandemic, further questioned this direction of reform. We emphasize the need to expand and develop a framework of health systems and policy studies that are more appropriate to the achievement of universal health care, health equity, and health rights in the Indian context.


Subject(s)
COVID-19 , Health Services Accessibility , Health Care Reform , Human Rights , Humans , India , Pandemics , SARS-CoV-2
5.
Acta Biomed ; 92(S6): e2021472, 2021 10 19.
Article in English | MEDLINE | ID: covidwho-1504958

ABSTRACT

Between August and September 2021, the European Court of Human Rights rejected three requests for interim measures against France and Greece's compulsory vaccination statutes against COVID-19. Due to the procedural nature of the interim measures, however, the status of vaccine mandates against SARS-CoV-2 under the European Convention of Human Rights has not been addressed. The paper argues that COVID-19 compulsory vaccination is consistent with both the text and the original understanding of Article 8 of the Convention. Moreover, considering pertinent case law on medical mandatory treatments, COVID-19 vaccine mandates should also square with the European Court of Human Right's "living instrument" doctrine. For this reason, it is expected that the European Court of Human rights will uphold COVID-19 vaccination programs. At the same time, it would be beneficial if more Council of Europe member states triggered Article 15 derogation mechanism in order to make an even stronger case for fast-track developed vaccines and contrast vaccine hesitancy.


Subject(s)
COVID-19 Vaccines , COVID-19 , Human Rights , Humans , SARS-CoV-2 , Vaccination
6.
Cuad Bioet ; 32(106): 329-339, 2021.
Article in Spanish | MEDLINE | ID: covidwho-1498355

ABSTRACT

The present article offers an analysis from a bioethical perspective of the treatment provided to senior citizens in the context of the COVID-19 pandemic. To begin with, the article highlights the paradox that exists when measures are adopted for the care of elderly people during a pandemic, and in some occasions the age of the patient is the determining factor for deciding whether to provide care or not in cases of scarcity. The question that arises then is: What is the adequate treatment for senior citizens? Using the Inter-American Convention on the Protection of the Human Rights of Elderly Persons as a point of reference, this article assesses the problem of the scarce resource allocation in the Third Age during a pandemic. As a conclusion, the pandemic is a great opportunity to reflect on the respect that we should give to every human being at every stage of his/her life.


Subject(s)
COVID-19 , Pandemics , Aged , Attention , Female , Human Rights , Humans , Male , SARS-CoV-2 , United States
7.
BMJ Glob Health ; 6(7)2021 07.
Article in English | MEDLINE | ID: covidwho-1476522

ABSTRACT

Migration health is affected by decision making at levels ranging from global to local, both within and beyond the health sector. These decisions impact seeking, entitlements, service delivery, policy making and knowledge production on migration health. It is key that ethical challenges faced by decision makers are recognised and addressed in research and data, clinical practice and policy making on migration health. An ethical approach can provide methods to identify ethical issues, frameworks for systematising information and suggesting ethically acceptable solutions, and guidance on procedural concerns and legitimate decision making processes. By unpacking dilemmas, conflicts of interests and values at stake, an ethical approach is relevant for all who make decisions about migration health policy and practice. Adopting an ethical approach to migration health benefits governments, organisations, policy makers, health workers, data managers, researchers and migrants themselves. First, it highlights the inherent normative questions and trade-offs at stake in migration health. Second, it assists decision makers in deciding what is the ethically justifiable thing to do through an 'all things considered' approach. Third, ethical frameworks and technical guidance set normative and practical standards for decision makers facing ethical questions - from 'bedside rationing' to collection of big data or in policy making - that can ensure that migrants' interests are considered. Fourth, there is a need for greater transparency and accountability in decision making, as well as meaningful participation of migrant groups. An ethical approach connects to public health, economic and human rights arguments and highlights the urgent need to mainstream concerns for migrants in global and national health responses.


Subject(s)
Health Policy , Policy Making , Human Rights , Humans , Public Health , Public Policy
10.
Int J Prison Health ; ahead-of-print(ahead-of-print)2021 10 03.
Article in English | MEDLINE | ID: covidwho-1447742

ABSTRACT

PURPOSE: The purpose of the paper was to conduct a legal-realist assessment of the South African prison system response to COVID-19. Severely congested and ill-resourced prison systems in Africa face unprecedented challenges amplified by COVID-19. South Africa has recorded the highest COVID-19 positivity rate in Africa and, on March 15th 2020, declared a national state of disaster. The first prison system case was notified on April 6th 2020. DESIGN/METHODOLOGY/APPROACH: A legal-realist assessment of the South African prison system response to COVID-19 in the 12 months following initial case notification focused on the minimum State obligations to comply with human rights norms, and the extent to which human, health and occupational health rights of prisoners and staff were upheld during disaster measures. FINDINGS: A legal-realist account was developed, which revealed the indeterminate nature of application of South African COVID-19 government directives, ill-resourced COVID-19 mitigation measures, alarming occupational health and prison conditions and inadequate standards of health care in prisons when evaluated against the rule of law during State declaration of disaster. ORIGINALITY/VALUE: This legal-realist assessment is original by virtue of its unique evaluation of the South African prison system approach to tackling COVID-19. It acknowledged State efforts, policymaking processes and outcomes and how these operated within the prison system itself. By moving beyond the deleterious impacts of the COVID-19 pandemic on the already precarious South African prison system, the authors argue for rights assurance for those who live and work in its prisons, improved infrastructure and greater substantive equality of all deprived of their liberty in South Africa.


Subject(s)
COVID-19 , Communicable Disease Control/legislation & jurisprudence , Communicable Disease Control/standards , Prisons/legislation & jurisprudence , Prisons/standards , Communicable Disease Control/organization & administration , Human Rights , Humans , Prisons/organization & administration , SARS-CoV-2 , South Africa/epidemiology
12.
Maturitas ; 154: 31-45, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1415643

ABSTRACT

Health problems of women experiencing homelessness are driven either from the usual background characteristics of this population, or from the homeless lifestyle. Apart from poverty and unemployment, transition to homelessness is often associated with substance abuse, history of victimization, stress, poor mental health and human immunodeficiency virus (HIV). Water insecurity can undermine bodily hygiene and dental health, posing a greater risk of dehydration and opportunistic infections. Exposure to extreme environmental conditions like heat waves and natural disasters increases morbidity, accelerates aging, and reduces life expectancy. Nutrition-wise, a high prevalence of food insecurity, obesity, and micronutrient deficiencies are apparent due to low diet quality and food waste. Poor hygiene, violence, and overcrowding increase the susceptibility of these women to communicable diseases, including sexually transmitted ones and COVID-19. Furthermore, established cardiovascular disease and diabetes mellitus are often either undertreated or neglected, and their complications are more widespread than in the general population. In addition, lack of medical screening and contraception non-use induce a variety of reproductive health issues. All these health conditions are tightly related to violations of human rights in this population, including the rights to housing, water, food, reproduction, health, work, and no discrimination. Thus, the care provided to women experiencing homelessness should be optimized at a multidimensional level, spanning beyond the provision of a warm bed, to include access to clean water and sanitation, psychological support and stress-coping strategies, disease management and acute health care, food of adequate quality, opportunities for employment and support for any minor dependants.


Subject(s)
Aging , COVID-19 , Food Insecurity , Health Status , Homeless Persons/psychology , Human Rights , Mental Health/statistics & numerical data , Substance-Related Disorders/complications , Aging/physiology , Aging/psychology , Female , Food , Humans , Reproductive Health , SARS-CoV-2 , Stress, Psychological , Substance-Related Disorders/psychology , Water Supply
14.
Biomed Res Int ; 2021: 6658070, 2021.
Article in English | MEDLINE | ID: covidwho-1376535

ABSTRACT

In light of the devastation caused by COVID-19, the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and vaccine research and development (R&D) have been occupying a prominent position in the field of global health diplomacy (GHD). Most countries, international organizations, and charitable organizations have been engaged in the R&D of COVID-19 vaccines to ensure timely affordability and accessibility to all countries. Concomitantly, the World Trade Organization (WTO) provides some provisions and enforcements regarding copyrights, patents, trademarks, geographical indications, and industrial designs. Given these safeguards, it is considered that intellectual property rights (IPRs) have become major barriers to the affordability and accessibility of vaccines/medicines/technology, particularly to the developing/least developed countries. Realizing the gravity of the pandemic impact, as well as its huge population and size, India has elevated this issue in its global health diplomacy by submitting a joint proposal with South Africa to the World Trade Organization (WTO) for a temporary waiver of IPRs to ensure timely affordability and accessibility of COVID-19 medical products to all countries. However, the issue of the temporary waive off had become a geopolitical issue. Countries that used to claim per se as strong advocates of human rights, egalitarianism, and healthy democracy have opposed this proposal. In this contrasting milieu, this paper is aimed at examining how the TRIPS has become a barrier for developing countries' development and distribution of vaccines/technology; secondly, how India strategizes its role in the WTO in pursuant of its global health diplomacy? We conclude that the IPRs regime should not become a barrier to the accessibility/affordability of essential drugs and vaccines. To ensure access, India needs to get more engaged in GHD with all the involved global stakeholders to get strong support for their joint proposal. The developed countries that rejected/resisted the proposal can rethink their full support.


Subject(s)
COVID-19 Vaccines/immunology , COVID-19/immunology , Diplomacy/methods , Drug Industry/methods , Global Health , Health Services Accessibility , Human Rights/methods , Humans , India , Public Health/methods , SARS-CoV-2/immunology
16.
Glob Public Health ; 16(8-9): 1454-1467, 2021.
Article in English | MEDLINE | ID: covidwho-1364689

ABSTRACT

Youths living in crowded impoverished urban areas face higher risk of infection by SARS-CoV-2. This article presents lessons learned from a preventive intervention project intersected by the COVID-19 crisis that moved from a mix-methods study design to online ethnography. The 'home-officed' research team e-witnessed high-school students' daily lives and collaborated in youths' and community-based organisations' responses in the territories where they study and live. Psychosocial distress increased, also driven by the disastrous governmental response to the health and economic crises. There was growing anxiety about meeting friends and dating, with structural limits for sustaining the recommended social distancing, which added to gender/sexuality-based violence. Simultaneously, we observed students becoming relevant actors through co-producing preventive practices, surpassing risk-group notions and combining SARS-CoV-2 prevention with sexuality, gender, racism and mental-health issues. They managed internet-mediated applications to promote critical thinking and collective actions aimed at health promotion among their peers, from their homes. Freire's concept of 'untested-feasibility' fostered researchers', students' and community leaders' imaginations in the face of this unprecedented crisis, thereby enhancing social responses to the epidemic to become rights-based comprehensive dialogical preventive activities. This ongoing intervention-research stresses how prevention sciences can go beyond reduction of this pandemic to a viral event.


Subject(s)
COVID-19 , Human Rights , Pandemics , Adolescent , Brazil/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Pandemics/prevention & control
17.
J Law Med Ethics ; 49(2): 328-331, 2021.
Article in English | MEDLINE | ID: covidwho-1354061

ABSTRACT

While human rights law has evolved to provide guidance to governments in realizing human rights in public health emergencies, the COVID-19 pandemic has challenged the foundations of human rights in global health governance. Public health responses to the pandemic have undermined international human rights obligations to realize (1) the rights to health and life, (2) human rights that underlie public health, and (3) international assistance and cooperation. As governments prepare for revisions of global health law, new opportunities are presented to harmonize global health law and human rights law, strengthening rights-based governance to respond to future threats.


Subject(s)
COVID-19 , Global Health , Human Rights , Humans , International Cooperation , Pandemics , SARS-CoV-2
18.
J Int AIDS Soc ; 24 Suppl 3: e25724, 2021 07.
Article in English | MEDLINE | ID: covidwho-1351248

ABSTRACT

INTRODUCTION: The meaningful involvement of persons affected by a disease is a unique aspect of the HIV response that places people living with (PLHIV) and those directly affected by HIV (peers) at the centre of the design, development and implementation of service delivery and research and policy making. The principle of greater involvement of PLHIV (GIPA) has and will increasingly ensure equitable access to services and engagement of marginalized groups in the HIV response, and to health services more broadly. This paper describes the history, current place in the HIV response and potential future role of PLHIV and communities in health responses. DISCUSSION: Historically, the role of communities of PLHIV and peers in service delivery, research and drug development, advocacy, social and political accountability, resource mobilization and social and human rights protection is well documented. Their leadership and engagement have contributed directly to improved outcomes in access to HIV treatment, prevention, support and care services around the world. Their continued and expanded role is especially important for the future success of HIV responses in sub-Saharan Africa, where the HIV burden remains the greatest. The lessons learned from the leadership and involvement of communities of PLHIV and peers in the HIV response hold value beyond HIV responses. The models and approaches they have efficiently and effectively utilized have relevant applications in addressing shortfalls in health systems in the COVID-19 era, as well as broader, more integrated health challenges as countries move to develop and operationalize universal health coverage (UHC). However, neither HIV nor other health and development targets can be met if their contributions are not adequately recognized, valued and funded. CONCLUSIONS: The past three decades have demonstrated that communities of PLHIV and their peers are instrumental in sustaining engagement and advocacy for health equity and financing for health and ensuring that the human rights of all people are recognized and upheld. Quality and effective integration of health systems and UHC can be more effectively designed, implemented and sustained with communities of PLHIV and peers at the centre.


Subject(s)
COVID-19/prevention & control , HIV Infections/prevention & control , HIV-1 , Health Services , Human Rights , SARS-CoV-2 , Africa South of the Sahara/epidemiology , COVID-19/epidemiology , Government Programs , HIV Infections/epidemiology , Health Equity , Health Services Accessibility , Humans , Peer Group , Social Responsibility
19.
J Infect Dev Ctries ; 15(7): 910-12, 2021 07 31.
Article in English | MEDLINE | ID: covidwho-1339634

ABSTRACT

Confirmed new cases of Coronavirus disease 2019 (COVID-19) have accelerated in Sub-Saharan Africa against a backdrop of fragile health systems, a high burden of comorbidities and socioeconomic instability. The context makes the region particularly vulnerable to the virus and its impact. As cases escalate, the need to tailor-make COVID-19-related response strategies to the African context is imperative. This paper aims to discuss key considerations on the public health response to the pandemic and its intersection with ethics and human rights. With this perspective, we bring attention to the conflict between healthcare workers' obligations and patient rights under the unclear policy and regulatory frameworks and the application of restrictive measures in the context of poverty. The indirect effects of the pandemic on already existing health problems are also highlighted. We appeal to the African States to establish appropriate systems which integrate human rights-based approaches to COVID-19 response. These systems should be ethically sound systems and ensure no-one is left behind in terms of testing, access to therapeutics and vaccination, and social protection; based on lessons learned over the past 12 months of the pandemic's presence in SSA, and patterns emerging across the globe.


Subject(s)
COVID-19/psychology , Health Personnel/psychology , Human Rights/ethics , Human Rights/legislation & jurisprudence , Public Health , Africa South of the Sahara/epidemiology , COVID-19/epidemiology , Comorbidity , Delivery of Health Care , Health Policy/legislation & jurisprudence , Humans , Poverty
20.
Arch Argent Pediatr ; 119(4): S107-S122, 2021 08.
Article in Spanish | MEDLINE | ID: covidwho-1325947

ABSTRACT

The Subcommittee on the Rights of the Child and the Social Pediatrics Committee of the Sociedad Argentina de Pediatría carried out a fieldwork that allowed us to give a voice to our children and adolescents (NNA), during quarantine and social isolation mandatory imposed in our country by the global pandemic COVID-19. The objectives were to analyze the impact on their feelings, emotions and desires; evaluate and compare personal, family and social repercussions pre, intra and post quarantine; and identify support and containment needs. The results of the research allow us to affirm that children have been the most vulnerable and the least listened to. The quarantine has had an enormous individual, social and family impact on children and adolescents and calls for a holistic, committed and joint approach from civil society, families, health professionals, teachers and political authorities.


Subject(s)
COVID-19/prevention & control , COVID-19/psychology , Child Welfare/psychology , Emotions , Perception , Quarantine/psychology , Social Isolation/psychology , Adolescent , Adolescent Health , Argentina , Child , Child Health , Cross-Sectional Studies , Human Rights , Humans , Interviews as Topic , Physical Distancing , Qualitative Research
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